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Eve Rivait rode her first horse when she was five, too small to get her feet through the stirrups, let alone give the animal a kick that registered. Yet even then, bouncing in the saddle, she was aware that being on the back of a horse provided relief from the boredom and isolation that, for her, were a more dominant part of growing up in Vermont than the snowcapped mountains and autumn foliage that draw millions of tourists to the state each year. As Eve got older, she began spending afternoons exercising the herd at Missy Ann Stables, not far from her home in Milton, a working-class town of about 10,000 located along Lake Champlain, some 30 minutes north of Burlington. Before she could drive a car, Eve was training horses at various barns in the area where seasoned farmhands asked about her knack for taming those with the wildest of temperaments. "Oh, I don't know," Eve would say, a sly grin forming on her round face, her lip piercing clicking against the bottom row of her teeth. "I guess they remind me of me."

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Away from the stables, she attracted the attention of adults in other ways. Skipping school. Clashing with teachers. Running away from a home where the disintegration of her parents' marriage – her mother worked for Homeland Security, her father as a project manager in construction – had created an environment more toxic than nurturing. In 2004, when Eve was 12, she discovered what seemed an easier way to rein in a mind that felt hard-wired to pinball from one extreme to the other. Her grandfather had just died of brain cancer, leaving behind a medicine cabinet stocked with the powerful opiate OxyContin, a substance Eve understood was prescribed by doctors to "make pain go away." She swallowed one. The sensation it produced was more seductive than any she had ever felt: Home, she thought. This is home. "I could be alone with myself," she says, "and not freak out."

Though it was a private solution to private pain, Eve was far from alone in discovering the pleasures of opiates. By the time she was 18, the same kids who once talked about the thrill of smoking pot were now praising the joys of "oxys," not to mention "vikes" and "perc-30s," the street names for Vicodin and the pale-blue 30-milligram tablets of oxycodone. Eve was out of high school, renting a room on the outskirts of Middlebury, a picturesque college town an hour south of Milton, when she started dating a boy who taught her that grinding and snorting the pills produced a more potent high. This led to a daily habit, though she never entertained the idea that she was developing a problem. An addict wouldn't be able to keep jobs at multiple stables. An addict couldn't make her rent and car payments on time. An addict didn't rescue a horse from a racetrack, as Eve did.

By the time Eve's relationship ended, six months later, another opiate was making a comeback. She had been dating her next boyfriend for only a few weeks when she came home to find him preparing to inject a needle filled with heroin into his arm – a sight so jarring it felt like a hallucination. Junkies, she thought, were people in places like the Bronx or Baltimore, not the middle of Vermont. But soon more people she knew were shooting up, and Eve's shock morphed into curiosity, heroin's corrosive reputation diminished by the fact that everyone compared it to a drug she'd already tried: "It's like oxys," she kept hearing, "only cheaper." So one evening, in the fall of 2010, distraught after her boyfriend stormed out in the wake of an argument, Eve took his stash from the bedside table. From her experience medicating horses she knew how to use a syringe; how much heroin to put in it, however, was a mystery. She opted for what she thought was a tiny amount – three small baggies of the beige powder. Moments after injecting it into her arm, Eve was on the bathroom floor, semi­conscious and unable to move.

On the afternoon of January 8th, Peter Shumlin, the governor of Vermont, entered Representatives Hall in the Vermont State House, in the capital, Montpelier, to deliver his annual State of the State address. With its famed dome capped in gold leaf, the building is as synonymous with Vermont in the popular imagination as maple-syrup refineries, ski resorts, the rugged ingenuity of Ethan Allen and the earnest marketing of Ben & Jerry's. As Shumlin began his speech, however, it became clear that he was less interested in extolling Vermont's pastoral reputation, as he had in the previous year's address, than in framing the experience of a resident like Eve Rivait within a larger, more ominous context. "In every corner of our state, heroin and opiate-drug addiction threatens us," he said, devoting the entirety of the speech – a startling gesture reflective of his maverick streak – to discussing the issue in a tone of blunt urgency: "What started as an OxyContin and prescription-drug-addiction problem in Vermont has now grown into a full-blown heroin crisis."

The portrait of the governor's native state that emerged was severe, conjuring up images more commonly associated with blighted inner cities than a state with the nation's fifth-lowest unemployment rate and a populace that is 95 percent white. Since 2000, Shumlin noted, Vermont has seen an eightfold increase in those seeking treatment for opiate use, with an almost 40 percent spike in the past year for heroin alone, and every day hundreds are languishing on waiting lists for understaffed clinics. Deaths from overdoses in 2013 had nearly doubled from 2012; property crimes and home invasions were on the rise; and close to 80 percent of the state's inmates "are either addicted or in prison because of their addiction." The same major highways where tourists routinely pull over to take photos of rustic vistas had, in the governor's description, become pipelines of heroin distribution, with organized gangs setting up outposts across the state, where a six-dollar bag of heroin in their home cities can fetch as much as $30. As a result, an estimated $2 million worth of opiates were now being trafficked into Vermont each week – a staggering amount for a state that, with only 626,000 residents, is the second-least-populated in the country, after Wyoming.

Within Vermont, where reports of heroin's rise had become fixtures in local papers for more than a year, Shumlin was applauded for turning up the volume on an alarm that had already been sounded; nationally, the attention his address garnered was filtered through a lens of morbid curiosity. HOW DID IDYLLIC VERMONT BECOME AMERICA'S HEROIN CAPITAL? read the headline on the website Politico, reinforcing the idea that what Shumlin was confronting was an aberration – an urban scourge freakishly resurfacing in the least likely of rural sanctuaries. Two weeks after Shumlin stepped down from the podium, however, 22 people died in Pennsylvania in a single week from injecting heroin laced with fentanyl, a narcotic that can be 100 times more potent than morphine. A few days later, four died from a similar mixture in Flint, Michigan, a city long defined by economic hardship, while authorities in Maryland, the richest state in the country, reported 37 similar deaths since last September. Then, on February 2nd, the actor Philip Seymour Hoffman was found dead, a needle still in his arm, after which reports of heroin outbreaks became so ubiquitous it seemed you could throw a dart at a map of the U.S. and land on its heroin capital. Northern Kentucky, central Florida, western Massachusetts and northwestern Indiana were all under siege, to say nothing of Ohio, Delaware and Wisconsin. President Obama's "drug czar," R. Gil Kerlikowske, weighed in, warning the nation that "there is no question we're seeing a resurgence of heroin."

With its sparse population spread throughout towns less populated than single blocks in major cities, Vermont stands out as a state where, perhaps more than any in the nation, the complexity and consequences of heroin's current rise come into grim focus. Unlike residents of New York City, who may be surprised to learn that fatal overdoses there increased 84 percent between 2010 and 2012 – a spike diluted among a population of 8.3 million – rare is the Vermonter who does not have a heroin story to share. The CEO whose daughter died of an overdose. The counselor at the treatment clinic robbed in broad daylight. The neighborhood coalitions in quaint hamlets trying, and failing, to keep their blocks from becoming open-air drug markets. The nearly 700 bags seized in Westminster from under the car seat of a five-year-old girl. Not long ago, in Burlington, a 29-year-old former user sits inside a coffee shop on a busy thoroughfare lined with outdoorsy boutiques, yoga studios and craft breweries, telling his own story of addiction and recovery. He stops himself midsentence and nods at the two people next to him who are in the process of conducting a deal. "See that?" he says. "The shit is everywhere."

Vermont is one of the most forward-thinking states in the nation, with a history of taking pioneering, unorthodox approaches to complex issues. It was the first to create civil unions for same-sex couples, in 2000, and last year, under Shumlin, announced single-payer health insurance and decriminalized marijuana. In February, six weeks after delivering his State of the State, Gov. Shumlin sits in his office, the panoramic view from the wraparound windows obscured by snow flurries, where he makes it clear that he wants his approach to heroin to be an extension of this pragmatism. "The theory has been that if we just arrest users and put them away, then we're going to make progress," says the 58-year-old Shumlin, who, with his chiseled jaw and shock of salt-and-pepper hair, personifies the self-reliant, affably renegade spirit of the state he presides over. "Public policymakers have refused to say not only that this has failed, but that it's failing miserably." He is a passionate man, but also a practical one, and he has made it his priority to reframe the issue in terms of public health: understanding addiction as a disease, bolstering treatment infrastructures and creating a culture where the collective empathy felt toward an addicted Oscar winner can extend to anonymous addicts before they arrive at the morgue. By March, Eric Holder, the U.S. attorney general, was advocating Shumlin's approach on a national stage, deeming heroin "an urgent public-health crisis," calling for reduced mandatory minimums for minor drug charges, and making it clear that the situation in Vermont is all the more disturbing and relevant when understood not as an anomaly but as a microcosm of a pandemic that extends far beyond its bucolic borders.

Eve Rivait did not hear Shumlin's speech. A month shy of turning 22, she was in a situation that afternoon that would have once seemed unfathomable: homeless during Vermont's brutal winter, looking for a place to sleep other than the back seat of her Ford Escape, in which a week earlier she had shivered through an ice storm, and still coming to terms with the course her life had taken since that evening four years ago, when she first tried heroin. Regaining consciousness in the bathroom, she found she'd been dragged into the shower, a stream of icy water jolting her awake, her boyfriend slapping her face to keep her from passing out again. A bout of vomiting followed, though this incident was not enough to erase the indelible impression heroin had made in the few moments before everything went black. Nearly a quarter of those who try it become addicted – more than any other illicit drug – and it was not long before heroin became the nucleus around which Eve's life orbited. "You can never re-create that first rush," she says, "but the whole time you're using, you're chasing it."

It is a snowy afternoon, three months since she was spending upward of $300 a day on heroin, Eve's third attempt at sobriety, and she is driving around the various parts of Vermont she's lived in, a meandering trip from the small towns in the north, into Burlington, then south toward Middlebury and its surroundings. Poised and articulate, with a natural sense of sardonic timing, Eve projects a punkish toughness – the tattoos, the piercings, the fluorescent streaks of color in her dark-brown hair – that gives way to a disarming vunerability as you get to know her. (A tattoo on her right forearm, stenciled in after a stint in rehab, reads HOLD ON PAIN ENDS – "hope" is the acronym.) The terrain outside – pastures where cows huddle together for warmth, towns marked by twists of smoke rising from wood-burning stoves – takes on a different quality in the company of Eve, who often interrupts herself to point out sights that fit into her narrative: "See that house there? Heroin." "That dude on the sidewalk with his eyes pinned? Junkie." "Used to cop in the trailer behind that house all the time."

In the past, the blame for the resurgence of any drug, especially one as stigmatized as heroin, has been placed on the shoulders of drug cartels and the dealers who hawk their product. But as Eve's path to heroin illustrates – and as Shumlin made clear by linking heroin to drugs like OxyContin – what makes the surge in Vermont and elsewhere all the more confounding is that it seems connected to one of the rare successes in the nation's 40-year War on Drugs: the recent crackdown on pharmaceutical painkillers. Eve's coming of age happened to coincide with a period during which prescriptions for these legal opiates were being written in astonishing numbers, with drugs manufactured for cancer patients and those suffering paralyzing levels of pain being given out to treat "conditions" as minor as root canals. In 2009, 257 million prescriptions for painkillers were dispensed from retail pharmacies, a 48 percent increase from 2000, and in 2010 enough painkillers were prescribed to treat all 242 million adult Americans around the clock for a month. It didn't take long for authorities to realize that large quantities were being "diverted" – to use the term that conflates Eve's misguided self-medication with wanton recreational use. Today, overdoses have surpassed motor-vehicle fatalities as the leading cause of accidental death in the nation, with the majority connected not to heroin but to legal substances attached to prescriptions.

In the past few years, however, more stringent prescription guidelines were enacted, leading to the closures of "pill mills," the pain clinics where doctors of questionable ethics were known to write prescriptions under dubious pretexts. In 2010, Purdue Pharma, the manufacturer of OxyContin, was pressured to reformulate the drug – one it first marketed to doctors as "virtually nonhabit-forming" – so the pills would turn into a gelatinous substance when crushed, making it difficult to condense the drug's 12-hour release into a single hit by snorting or injecting it. ("Gummies," they are called on the street.) While these combined efforts led to a sharp decline in availability, they also grossly inflated the prices for black-market pharmaceuticals and didn't eliminate the fact that a handful of billion-dollar pharmaceutical giants had unintentionally created "gateway" drugs to heroin of extraordinary persuasiveness – each one given the reassuring stamp of approval by the FDA. To the cartels in Mexico and South America in the business of supplying the U.S. with the bulk of its heroin, a drug derived from the seeds of poppy plants grown primarily in Afghanistan and Mexico, the clampdown on pharmaceutical exuberance presented an opportunity of unprecedented scope: Heroin, a drug that had been a hard sell for a generation, could now be promoted to the scores of Americans like Eve who had gotten a taste of opiates – with the market for potential customers larger and more diverse than ever. Increased demand created lower prices, and today 77 percent of recent heroin users say they switched to the drug after first trying prescription painkillers.

"The first time I shot up, it was just down that road there," says Eve, gesturing across a snow-covered meadow and explaining that, in the beginning, it was easy to rationalize using. Despite the popular perception of heroin as a drug that immediately incapacitates users, the reality is more complicated: As opiates bind to receptors in the brain, the body builds a tolerance, and a regular user will often appear sober minutes after shooting up and can go about her day fully functional. For half a year, Eve hid her habit from everyone close to her. She continued working at stables, sneaking off to corners of the barn to shoot up. Though she was "maintaining a life," it was one at odds with her perception of herself as "a little Vermont girl who rides ponies." As money became an issue, she ignored bills and started stealing checks from her mother. When she began neglecting her horse, it was becoming evident that she had crossed a line familiar to addicts, in which the point of using has shifted from experiencing a transcendent high to keeping the pernicious symptoms of withdrawal at bay. "The part of my day that I dedicated to doing heroin, to finding and using, became the whole day," she says.

Eve tried to get sober for the first time in August 2012, when she was 20 and the anxiety of using became so overwhelming she considered ending her life by injecting a lethal amount. She decided to enter rehab, at which point she came up against the lack of sufficient services Shumlin has since made it policy to improve. "Every clinic I called had a waiting list," she remembers, describing an experience recognizable to addicts across the country. "One person I talked to, he even told me to just keep using until I found a bed." Eventually a vacancy opened up at the Brattleboro Retreat, a rehab center near Vermont's southern border with Massachusetts, where Eve spent a week detoxing on Suboxone, a synthetic opioid similar to methadone used to wean addicts off heroin. "But then, when I left, I was detoxing from the Suboxone, which is almost worse than heroin," she says. "Goose bumps, diarrhea, throwing up – you can't spin around the toilet fast enough." She relapsed the day she got out, her habit escalating from three bags a day to three "buns," or "bundles," the term for 10 bags, which in Vermont sell for around $200 each, twice the rate in major cities. She resumed stealing from her mother, who pursued charges against her for check fraud. Out of work, Eve supported herself by giving her dealer rides to his supplier in Massachusetts in exchange for gas money and free product. "Slumlords, crack shacks, Puerto Rican gangs," she says. "Suddenly I'm in this very harsh world."

One day in the late summer of 2012, Eve was in the supplier's house, a lair dark at all hours thanks to the ratty blanket hung over the window. She had just shot up, and was sitting on the beat-up maroon couch, when the dealer who lived there answered his cellphone, shouting at the person on the other end. From what Eve could determine, he was speaking with a customer who, already in debt, was asking for another advance to keep from getting sick. "Finally, he said, 'Come by, you'll get what you want,' so obviously this guy runs over," Eve recalls. "He lets him into the house, and – boom – the minute the door shuts he pulls out a gun and shoots him in the head." While the floor was scrubbed with bleach, the corpse was wrapped in a tarp, then a carpet, then driven off in a waiting car. "The Vermont guys I was dealing with before, they kind of cared," Eve says. "If you owed money it wasn't a big deal. If you burned them, you were done as a customer, but they weren't going to shoot you."

The last significant surge in heroin use, in both Vermont and the nation, began in the late Nineties. Matthew Birmingham, the commander of the Vermont Drug Task Force, was working as a road trooper at the time. "An enormous bust for us would be 100 bags," he says, sitting behind his desk at the unit's headquarters in Waterbury, 27 miles east of Burlington. "Today, 5,000 is common. One week last year, we had a 3,000-bag seizure, then another 1,000, then 4,000." For Birmingham, a tall and fit man with a straight-laced demeanor, that was the moment when the magnitude of what was happening became almost overwhelming. "I'm sitting there with my bosses and we're all like, 'This is never-ending.'"

Vermont, from a dealer's point of view, is uniquely fertile terrain. The rash of painkiller abuse during the 2000s was especially pronounced in rural areas, where the combination of poorer, Medicaid­reliant populations and lack of proximity to medical facilities resulted in overworked doctors turning to opiates as a cure-all. Vermont now had a high density of potential heroin users, and the state happens to be a short drive from New York City, long the country's epicenter of distribution, as well as satellite cities like Springfield and Lowell, in Massachusetts; Hartford, Connecticut; and the Albany region in New York. Factor in a national prison system where small-town criminals forge relationships with members of big-city gangs, which continue when they're released, and the sophisticated network of distribution Birmingham lays out seems almost predestined. Dealers from these cities now drive into Vermont on a daily basis, setting up shop in either roadside motels or a trusted customer's residence – "trap houses," as they're known, a term made popular by the rapper Gucci Mane – unloading product so fast they've vanished just as police are getting wind of what's going on. "Fourteen years ago, heroin was only in urban areas," Birmingham says. "That's all out the window now. Suppliers are getting smarter, establishing themselves out where there's no police."

The following evening, Birmingham drives to Rutland, a city in southwestern Vermont, where John Deere, the tractor inventor, was born in 1804, but today has become a nexus of the state's heroin problem. As the sun sets, throwing contrails of magenta across the sky and silhouetting the jagged ridgeline of the Adirondacks to the west, Birmingham talks about how, for all the natural splendor, growing up in Vermont can be difficult for some. "Especially when you're young," he says, "there can be a feeling of being removed from the world." Combined with a socioeconomic landscape that increasingly provides opportunity only to those already born with it, the underlying complexity of the matter begins to take shape. "Kids today don't feel part of anything," says Jessi Farnsworth, who works at HowardCenter, an organization that runs treatment clinics in Vermont. "People need to feel appreciated, that their contribution is important. When people feel isolated, it's easy to want an escape from reality."

As Birmingham pulls into Rutland, he points out the vacant storefronts on Main Street and the plywood boards nailed over the windows of dilapidated Victorians – signs of the "lack of hope and opportunity" Shumlin alluded to improving in his speech. Once a thriving industrial stronghold known for its marble quarries, Rutland, like towns throughout the nation, has struggled to find an identity as its backbone industry dries up. And with a population of 16,000, the city is just big enough to ensure a dealer customers, but small enough that law enforcement remains spotty. "Kind of a perfect storm," says Birmingham.

He stops into the State Police Barracks on the edge of town. Inside, he is met by Lt. John Merrigan, a burly 45-year-old. Merrigan has offered to give a tour of the 10-block section of Rutland that "has been hit the worst," and just before setting off he doubles back to retrieve his gun. "You never know," he says. Though the violent turf wars that often accompany the drug trade have not become an issue in Vermont, where members of the Crips and Bloods do business alongside one another, there is concern that Vermont's lax gun laws have resulted in drugs being bartered for firearms. Passing a Stewart's market on the corner of State and Grove, Merrigan recalls that, in 2010, a convicted New York state dealer was shot dead in the parking lot after pulling a .380 on one of Merrigan's state troopers.

"This is where you start to see it," Merrigan says, crossing Grove into a neighborhood that at first looks indistinguishable from countless others in the state. "In the snow it looks almost nice, doesn't it?" he says. "But come back in the summer, and you'll see dirt where there should be grass, trash in lawns. And keep in mind most of these old houses have been diced up into apartments. Shitholes, really." On a run-down street with the incongruous name of Park Avenue, the car comes to a crawl in front of three adjacent homes that, last summer, emerged as a hub of heroin sales. "The openness of it, just walking around with drugs, making deals in front of the neighbors – you used to not have anything like that in Vermont," Merrigan says, describing a world familiar to viewers of The Wire. Last September, an early-morning raid on all three properties resulted in the arrests of five major dealers. "That was a good hit," says Merrigan, "but someone will take their place." He glances out the window. "Probably someone already has."

If there is hope to be gleaned, it is that the approach Vermont is taking stands as a counterpoint to trends that have proved futile in combating drugs for generations. Unlike Maine's Tea Party governor, Paul LaPage, who used his State of the State to advocate fighting the heroin crisis by increasing law enforcement so they can "hunt down dealers and get them off the street," Shumlin's core initiatives – expanding treatment programs and funneling addicts into them instead of prison – are already being embraced as models for the rest of the country. In Chittenden County, which includes Burlington, T.J. Donovan, the State's attorney, has implemented a program that screens those arrested, allowing nonviolent offenders to avoid the matrix of the judicial system in favor of treatment. Last November, when a clinic opened in Rutland, Shumlin was on hand to cut the ribbon; and in March, the governor announced a plan to put naloxone, a fast-acting drug that reverses overdoses, into the vests of every trooper in the state. Shumlin's idea that "we can't arrest our way out of this" has been adopted by law enforcement, who are adamant that their efforts are now focused on going after what Birmingham calls the "tier one and tier two" dealers responsible for dispersing large quantities of drugs. The difficulty is that the line separating a desperate addict from a predatory dealer is rarely clear.

Case in point: becoming a critical cog within a gang's shadowy distribution network was the furthest thing from the mind of Melissa Weston, when four years ago she snorted a line of OxyContin that had been cut for her to sample. She was 18, a spry, cherub-cheeked blonde who filled her Instagram feed with photos of sunsets above hashtags like "#ilovermont." Just out of high school, she was working part-time at Victoria's Secret in Burlington while going to cosmetology school; her mother, who died of leukemia when Melissa was 10, wanted to be a hairdresser, and Melissa dreamed of opening a salon. Unlike many her age, Melissa was well acquainted with the dangers of oxys; after her mother passed away, her father developed a habit that made him a family pariah. "I thought he was a dirtbag," she says. "I never thought I'd be doing drugs." But Melissa, who had spent the previous three years in foster care, was tired of feeling out of place. She did the line, sinking into the couch as its effects took hold. Soon after, she related her experience to a friend. "You know my boyfriend deals heroin, right?" her friend responded. "If you liked oxys, you should try H."

Dealers in New York are always on the lookout for users like Melissa, who snorted her first line of heroin that same week and began shooting it a month later. Fresh-faced Vermonters like her are less likely to attract attention from law enforcement, and are recruited to work as mules in exchange for free or discounted product. Within a couple of months, Melissa was making regular trips to Harlem in her Subaru. "We would bring in, like, 70 or 80 sleeves a week," she says, a "sleeve" being a term for 100 bags, making each of Melissa's regular shipments major trafficking offenses on par with a 9,000-bag seizure the Vermont Drug Task Force made last fall, one of the largest in state history. Aside from the large quantities of drugs, she was often in proximity to serious money – she posted a photo on Instagram of $20,000 fanned out between her French-manicured nails and stuffed into her shirt – though most of it went back to the New York dealer in exchange for a small cut and a supply of heroin.

During some of her last few months of using, Melissa lived out of a trailer in a Burlington suburb, shoplifting from downtown boutiques and selling the clothes to secondhand stores. One day a dealer asked her out on what she thought was a date. Figuring she could flirt her way to a free high, Melissa agreed and the dealer took her back to the motel where he was staying. "There was already this woman in there, short blond hair, real skinny, just looked like garbage," Melissa recalls. "She was a prostitute and he was her pimp." Melissa was now shooting 20 bags a day and, when told the rates – $75 for half an hour, $150 for an hour – the prospect of money was enough to justify prostitution. The pimp had her pose for a series of provocative photos, promoting her on the website Backpage as a "college girl." Her first customer was a man in his thirties, the exchange limited to oral sex. She slept with the next john, who turned out to be her last. "He was, like, 350 pounds," she says. "It was the most degrading thing I've ever done."

This is not the life one associates with the professional drug dealer, yet Melissa was still driving into New York when the opportunity arose, and during her three years using she helped move tens of thousands of bags of heroin into the state. Had she been caught, she would be labeled a player, not a pawn – her arrest and lengthy prison term applauded as an example of the tougher penalties Shumlin is imposing on anyone who "transports illegal drugs into Vermont." Fortunately, a year ago she ended up getting busted in a drugstore parking lot, charged with possession of a small vial of liquid Valium. When her case came to court, she was offered the chance to have the charges dropped in exchange for getting treatment, and now stands as a testament to that initiative's benefits. "I didn't even want to go to rehab," she says. "My grandfather drove me, and I was shooting up all my stuff in the back of his car. But something changed when I was there." Now 21 years old, sober for eight months, Melissa works as a waitress at an Italian restaurant in Burlington and has begun to think about opening a salon once more.

Today, the waiting list for those seeking treatment in Vermont stands at more than 500, with the wait taking months, not days. In this, the state is far from unique. Addicts in northern Kentucky wait six months for one of the region's few beds, while those in Ohio, New Jersey and Delaware face similar predicaments. The discouragement this roots in one addict spreads to others, and a perception forms among users that help is but an elusive wish. While Shumlin is intent on eliminating waiting lists this year, doing so only begins to address the hurdles. Maintenance drugs like methadone and Suboxone have helped countless addicts find stability and hope, but the substances are controversial. Powerful opiates, they have been stolen and sold on the street as substitutes for heroin, fostering the idea, almost always exaggerated, that clinics are as much havens of drug abuse as they are bastions of sobriety. Last May, when HowardCenter was preparing to open a clinic in South Burlington in the fall, residents held protests resembling those seen outside abortion clinics in Christian-right strongholds: driving around the building, honking nonstop, demanding its closure.

"No one was protesting the cardiologist's office that was here before us, which was filled with drugs just as powerful as the ones we're distributing," says Bob Bick, who oversees substance-abuse services for the HowardCenter clinics. Sitting in the South Burlington clinic's kitchen on an early morning in February, the 250 patients treated daily filtering in despite a blizzard outside, he wears a fleece vest over a white button-down, and speaks in a raspy voice that emphasizes his jaded perspective on the matter. In his 40 years in the treatment business, Bick has grown fatigued by what he believes is a myopic view of the current epidemic. "Since the beginning of time, we have been promoting elixirs with the promise of easing pain," he says. "Turn on the TV, and you're assaulted with ads. Pills to give you an erection. To make restless-leg pain go away. To eliminate headaches, back pain. But when people turn to substances that we don't condone? We stereotype and stigmatize." He knows how he can sound: frustrated, even overzealous. Then again, heroin was first trademarked and introduced to the masses by Bayer, the German pharmaceutical company, and sold as an over-the-counter cough suppressant from 1898 to 1914. "Look, we do good work here," says Bick. "But as long as we keep thinking of addicts as 'those people,' we're not going to make any progress."

Treating addiction is an imperfect science. What works for some fails for others; relapses are part of the process; and compared with the money that goes into the prison system, both private and public, the funds directed toward treatment remain fingernail-thin across the country. In the effort to galvanize public opinion and replace fear with empathy, officials today emphasize that addiction does not discriminate: destroying, and sometimes ending, the lives of everyone from suburban teens to beloved actors. "But what about the people who aren't addicted, but who use functionally?" asks Jill Harris, managing director of strategic initiative at the Drug Policy Alliance. "Are they in less need of compassion? Do we leave them alone? These are important questions that are hard for people to get their heads around." For those seeking treatment, meanwhile, the socioeconomic factors can't be ignored; addiction can affect anyone, but its effects on the less fortunate are generally more damaging. An addict with disposable financial means can afford to use without turning to crime, and when he decides to get clean he can check in to a rehab center for as long as he needs. Users on Medicaid in Vermont who qualify for residential treatment are generally allowed two weeks, and while Shumlin often mentions that he can treat an addict for $136 a week – compared with the $1,138 it costs to care for someone in jail – even those who get past the waiting lists can discover that the outpatient support is less than adequate.

"I had my first dose today – finally," says Mike Maniery, a 31-year-old from Rutland, referring to the 30 milligrams of methadone that a nurse watched him swallow that morning at the new clinic in town. Now it is evening, and as Mike tucks himself into a booth inside a chain restaurant, the symptoms of withdrawal are beginning to take hold: the anxiety and muscle aches that will give way to vicious, flulike symptoms that can last for days. Mike has been using heroin for more than a year, having shot up for the first time on Halloween 2012. Prior to that, he mainly used Percocet, though the crackdowns in prescriptions had caused the price to double, from $20 to $40 a tablet. "I can't really tell you how or why I started," he says. "Boredom, mainly. It's boring as fuck around here, if you haven't noticed." For Mike, who is gay, his sexuality makes the limitations of living in a rural area all the more acute. "You can basically forget about ever finding a serious boyfriend here," he says.

A 2005 graduate of Green Mountain College, Mike owns a marketing consultancy. "But what I am is an addict. What I do is drugs." Wanting help, he called the clinic in Rutland the week it opened last year, but by then it was full, and he was put on a waiting list. When he learned he was accepted last week, he was hopeful, though already he is skeptical. "They want me to get sick tonight," he says, "so they can figure out the proper dosage. But I've been using 30 bags a day, and it's not like anyone's calling me to see how I'm doing."

At the restaurant, Mike's edginess increases. He picks up his phone, puts it back down. It is 12 hours until he is supposed to arrive at the clinic. He picks up his phone again, this time sending a text. "Fuck this," he says, and leaves to meet his dealer. Heroin users like Mike do not talk about the drug in terms of "getting high," but as a way to "get well" – the paradox of a lethal drug being used to stave off feelings associated with death. After he shoots up, the signs of physical illness, so visible before, recede almost instantaneously.

Shortly after witnessing the murder in Massachusetts, in 2012, Eve Rivait entered Serenity House, a rehab clinic in Rutland, and managed to stay clean for a year until relapsing last fall and entering the clinic again. She'd been kicked out of the apartment she was renting and was forced to give up her horse. She had nowhere to go. "That last relapse," she says, "I really lost everything." On her second day of detox, a doctor called her into his office to go over some of the tests all patients have to take upon entering, which is when Eve discovered that she was five weeks pregnant. Eve chose to keep the baby, a decision that has served as a stronger motivation to stay clean than any offered at the clinic. After leaving rehab, she had been promised a bed at the Lund house, in Burlington, a rehab center that serves pregnant women, but when she called she was informed that she needed to be at least 20 weeks pregnant to qualify. Soon Eve was crashing at the only place where she was still welcome – the house of a friend who was still using – but after a couple of weeks she opted for her car, where, as Gov. Shumlin spoke of the heroin crisis spreading throughout the state, Eve fell asleep imagining a different life. "I just want to give this baby a home," she says. "My goal is just to be a normal, boring person."

By March, after three months without a home, Eve has been given a bed at Lund. Still, she would like to find a way out of Vermont. "Once you've seen it the way I have," she says, "it can't go back to the happy place everyone thinks it is." She pulls into a gas station in Burlington, across the street from the promenade overlooking the frozen expanse of Lake Champlain. Shivering as she fills up her car, she is overcome by a bout of sneezing, hardly abnormal, though it catches the eye of a young man in a hooded fleece walking past. Sneezing is a common symptom of heroin withdrawal.

"Hey, baby, you sick?" he asks. "I think I have something that can help you."